Provider Demographics
NPI:1487669057
Name:SHECHTMAN, LEON MAYNARD (OD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:MAYNARD
Last Name:SHECHTMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NE 164TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4121
Mailing Address - Country:US
Mailing Address - Phone:305-940-0037
Mailing Address - Fax:305-940-1070
Practice Address - Street 1:2000 NE 164TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4121
Practice Address - Country:US
Practice Address - Phone:305-940-0037
Practice Address - Fax:305-940-1070
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620629800Medicaid
FL1613OtherPRIMARY PLUS
FLE4255ZMedicare ID - Type Unspecified
FL1613OtherPRIMARY PLUS